title: Major depressive disorder in breast cancer: a critical systematic review of pharmacological and psychotherapeutic clinical trials.
abstract: BACKGROUND
  While women with breast cancer often face varying levels of psychological distress, there is a subgroup whose symptomatology reaches a threshold for diagnosis of major depressive disorder (MDD). Major depressive disorder is known to influence patient outcomes, such as health-related quality of life and treatment adherence. There are no systematic reviews that evaluate pharmacological and psychotherapeutic treatment trials for MDD among individuals with breast cancer.
  
  
  METHODS
  Two authors independently searched MEDLINE, EMBASE, Cochrane and Clinical Trials.gov databases through February 20, 2013 without language restrictions. Core journals, reference lists and citation tracking were also searched. Articles on breast cancer patients were included if they (1) included participants with a diagnosis of MDD; (2) investigated pharmacological or psychotherapeutic treatments for MDD compared to placebo or usual care in a randomized controlled trial (RCT).
  
  
  RESULTS
  Two RCTs on antidepressant treatment met inclusion criteria. However, no RCTs investigating the effects of psychological treatments for MDD in breast cancer were identified. Notwithstanding the paucity of data investigating the effects of psychological treatments for MDD in breast cancer, numerous psychotherapeutic strategies targeting depressive symptoms were identified. Mianserin had significant antidepressant effects when compared to placebo in a 6-week, parallel-group, RCT of Stage I-II breast cancer in women with MDD. Desipramine and paroxetine were reported to be no more efficacious than placebo in a 6-week, RCT of Stage I-IV breast cancer in women with MDD.
  
  
  CONCLUSIONS
  The evidence reviewed herein underscores the paucity of data available to guide clinicians in treatment decisions for MDD in individuals with breast cancer. Therefore, the treatment of MDD in breast cancer is primarily based on clinical experience. Some antidepressants (for example, paroxetine) should be avoided in women concurrently taking tamoxifen due to relevant interactions involving the cytochrome CYP2D6.
authors.affiliation: Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil. Electronic address: andrefc7@terra.com.br.
authors.forename: André F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hyphantis
authors.affiliation: Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Paulo Marcelo G
authors.initials: PM
authors.lastname: Sales
authors.affiliation: Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Márcio G
authors.initials: MG
authors.lastname: Soeiro-de-Souza
authors.affiliation: Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Macêdo
authors.affiliation: Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Cha
authors.affiliation: Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.affiliation: Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pavlidis
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000150:complications*; D002986:Clinical Trials as Topic; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D011613:Psychotherapy / Q000379:methods*
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant agents; Breast neoplasms; Clinical trials; Depression; Psychotherapy; Systematic review